What is the prognosis of lymphedema?

Updated: Mar 24, 2021
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: William D James, MD  more...
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The outcome for persons with lymphedema depends on its chronicity, the complications that result, and the underlying disease state that caused the lymphedema. (Primary lymphedema usually does not progress, with the condition stabilizing after several years of activity.)

Patients with chronic lymphedema for 10 years have a 10% risk of developing lymphangiosarcoma, the most dreaded complication of this disease. Patients with this tumor commonly present with a reddish purple discoloration or nodule that tends to form satellite lesions. It may be confused with Kaposi sarcoma or traumatic ecchymosis. This tumor is highly aggressive, requires radical amputation of the involved extremity, and has a very poor prognosis. [37, 38, 39, 40, 41, 42, 43]

The 5-year survival rate for lymphangiosarcoma is less than 10%, with the average survival following diagnosis being 19 months. This malignant degeneration is most commonly observed in patients with postmastectomy lymphedema (Stewart-Treves syndrome), in whom the incidence is estimated to be 0.5%. [44]

Other neoplasms identified in areas of chronic lymphedema are squamous cell carcinoma, Kaposi sarcoma, [42, 45] B-cell lymphoma, [46] and malignant fibrous histiocytoma.

Complications of lymphedema also include recurrent bouts of cellulitis and/or lymphangitis, bacterial and fungal infections, lymphangio-adenitis, deep venous thrombosis, severe functional impairment, cosmetic embarrassment, and necessary amputation. Some patients may develop protein-losing enteropathy and visceral involvement. Chylous ascites and chylothorax can develop but are rare. Amyloidosis has been described as a complication of primary lymphedema. [47, 48]

Complications following surgery are common and include partial wound separation, seroma, hematoma, skin necrosis, and exacerbation of foot or hand edema.

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